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Patterns of Health Care in Ontario
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C. David Naylor, Geoffrey M. Anderson, and Vivek Goel; eds. 329 pages. Ottawa: Canadian Medical Association; 1994. $89.95.
Medicine is undergoing a major transformation. Increasingly, medical practice will be based on evidence and populations, and this new medicine will require high-quality information and analysis.
An extraordinary example of just the kind of information and analysis needed is now available in this text, the first of a series of practice atlases promised by the Institute for Clinical Evaluative Sciences in Ontario. The atlas presents population-based data, and thoughtful commentary is dispersed throughout.
The data come from three primary sources: the Hospital Medical Records Institute, hospital-based care and discharge records, and the 1990 Ontario Health Survey, a population-based survey of most of the Ontario population that includes Ministry of Health mortality data. The major focus of this atlas is hospital care, but considerable information about health status and mortality is provided. A fascinating chapter relates the use of ambulatory services to health status and socioeconomic indicators.
Among the more remarkable aspects of the book are the interspersed critical analyses. One of these is an analysis of appendectomies in Ontario: In recent years, the preoperative accuracy of diagnosis among women has increased, but so has the rate of perforation. The interpretation of the data suggests that increasing preoperative accuracy correlates with an increased rate of perforation. However, the higher rate of perforation when associated with watchful waiting in the hospital seems not to be associated with increased mortality or length of stay.
Information about hospital care and costs is provided in great detail. Some of the data are relatively old; for example, days of care per thousand are reported for 1987. Readers from the United States will find it intriguing that the Ontario Health System has not exerted pressure—as has the United States—to force reductions in hospital use and in length of stay. One chapter presents patterns of drug use among the elderly for several medical conditions and includes the associated costs.
This remarkable book provides a wealth of population-based data and critical analyses. Although it can be read in its totality, it will probably be most useful as just what the authors have intended: an atlas of information that can be used for comparative purposes and a source of information about specific areas of interest. It represents a breakthrough in the presentation of relevant and useful data and comes just when information of this sort is needed. We in the United States should applaud the efforts of the Institute for Clinical Evaluative Sciences in Ontario.
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